Section 14
Techniques
for Treating Couples

Violence-eliminating strategic interventions must be melded with family
therapy techniques in order to treat couples. These cognitive-behavioral-communications
strategies include crisis intervention, treating aggression and homework assignments.
Crisis
Intervention
Treating violence means intervening in crises; it is to be
employed upon any threat of violence or if battering has occurred. The goal of
the intervention is to solve the presenting problem (the crisis) through immediate
response, focusing on the presenting problem with a determination of psychological
and physical safety, and issuing a directive that results in a solution to the
problem.

An anxious and panicked Mary called as directed to say that Fred
was very angry, and she was afraid he would become violent. He had been threatening
her and the family. In the background, I could hear Fred throwing furniture; Mary
was yelling at him to stop, which fueled his anger. I directed Mary to stop telling
him to stop because it was making him angrier and to tell Fred that I wanted to
speak to him. He refused. I told her to tell him that he promised to talk to me
should he feel out of control. It took three tries, but he finally came to the
telephone.

He started the conversation by calling Mary a bitch and telling
me in a loud voice how she made him get angry at her. I directed him to calm down,
stop talking, and listen. I reminded him of his contract. He said he did not give
a damn about any contract and that she had provoked him. I interrupted, saying
it did not matter what his reasons were or who provoked what. What counted was
that he needed to control his anger so that she did not leave him, the police
would not be called, and he did not feel badly after the episode was over. I told
him if he refrained from hitting her, he would feel better about himself, and
that was the goal of the counseling. Did he remember that? He said, Yes,
but . . . several times, with my interrupting him every time reminding him
that he made a deal to follow the contract, and that is what he had to do now.
The issue was too hot for them to deal with alone and needed to be discussed in
a session. He finally agreed. I asked him to repeat what his contract said and
what he had to do. I directed him to put Mary on the telephone so that I could
tell her what he and I agreed to.

Mary got on the telephone; she was agitated
and sobbing, so I suggested some relaxation techniques. I informed her about what
had transpired between Fred and myself and told her that they were not to talk
about the issue until the session because it was too volatile for them. I reminded
her that she had a part to play in Freds contract. He was to leave the house
for an hour. She was to let him go and not question him about where he went when
he returned. She agreed. I asked if she felt she was OK. She still felt scared.
I asked her if she wanted to visit her friend, as we agreed she would do if she
felt too shaken. She thought that was a good idea.

Potential for Violence
Family
violence cases always have a critical aspect to them because of the potential
for violence. When working with the couples, treating the aggression is the main
objective, but in that process, it is necessary to intervene in a crisis. The
goal of the intervention is to stop violence from occurring by influencing the
systemic behaviora different goal than is used when not treating the batterer.

Couples
presenting with violence need an opportunity to vent, complain, and even fight
in the presence of the worker. Most of them have bottled feelings and need an
opportunity for outpouring in a safe environment. Initially, they spill their
feelings in counseling sessions. Listening to the fights demonstrates to the couple
worker comfort with anger; more important, it demonstrates for the worker their
fighting patterns and the issues they fight about. Fighting for too many sessions,
however, repeats their patterns and serves to maintain homeostasis. Workers should
intervene in the fight after the patterns and issues are established for the worker
and direct them to stop fighting, since it is nonproductive. I attempt to allow
fighting to occur only in the initial session. Under no circumstances should it
continue later than the third session, with the worker moving the case along toward
the cessation of violence.

Treating Aggression
Eliminating the
violence is the reason to treat the aggression and is accomplished with several
procedures. Violence cannot be eliminated without the batterers motivation.
It can be assumed that if a batterer voluntarily enters treatment, he wants to
change, but because of his psychological defenses and his fear that change is
impossible, the worker needs to increase and make explicit his motivation. Implicit
to motivation is the batterers assuming responsibility for the battering.

Batterer
Responsibility
Most batterers, whether treated with or without their partners,
initially deny that battering is their responsibility or that they see reason
to stop. They may say, She makes me do it because she provokes me,
Knocking a woman around once in a while teaches her whos boss,
or I only gave her a little slap. In the face of the mans denials,
rationalizations, minimizations, and externalizations, workers need to remember
that batterers can and do change and they must understand defense mechanisms.
In spite of the batterers initial lack of admission that he alone is responsible
for the battering or that he needs to change that behavior, the worker proceeds
on good faith and the professional knowledge that if someone comes in for treatment
voluntarily, he wants to be there.

The first step is focusing
on having him acknowledge that he alone is responsible for the battering. When
a batterer tells me that he is not responsible (usually because she provokes him),
I often ask if he thinks other partners are provocative too. Then I wonder if
he thinks all men who have provocative partners respond with violence. This is
one root to his seeing his responsibility for violence. If he thinks that other
men may respond to provoking partners differently, he is faced with understanding
why he does not. If he does say that all men who are provoked by their partners
respond with violence, I question whether he can think of another way to respond,
even to the point of making suggestions (Why dont you just walk out?
Why dont you tell her you want her to stop provoking you?) in
an attempt to help him see that the way he responds is his choice. The object
of this initial step is to engage the batterer in order to develop a therapeutic
rapport that will eventually lead to a therapeutic alliance. If a batterer acknowledges
the domestic violence is his responsibility, then a dent has been made in his
defensive armour, and he is open to hear about his need to change.

The
second step deals with asking him how he feels when he hits her. Many people
cannot identify their feelings, and sometimes they resist talking about feelings.
But many batterers feel badly and guilty for their violent behavior or secretly
wonder if they are crazy. At the most superficial level, most men have been taught
as children that boys do not fight with girls. For men who cannot articulate their
feelings, I identify these feelings for them by saying something like, I
suspect you feel bad when you hit Joan. If I receive no verbal protest,
including silence, which I interpret as consent, I assume that he agrees with
me. Once a batterer admits that he feels badly about hitting his partner, he experiences
his behavior as ego dystonic.
The third step in treating aggression is to
develop a violence­eliminating contract. The contract is set up along lines
that are both cognitive and behavioral and is aimed at redirecting violent behavior
into nonviolent channels.
Contracts
The contract or agreement
is made with the batterers participation and a cooperative effort by the
partner. Its purpose is to teach self-control by delaying the urge to respond
to anger with violent aggression. His partners participation enhances bonding
and develops teamwork. When they are successful in carrying out the contract,
it is empowering and reinforcing.
The procedure is as follows:

RECOGNIZING
THE SIGNALS1.Teach the batterer to recognize the cues
that signal when anger will escalate to violencefor example, sweaty palms,
stomach knotting, increased heartbeat, lightheadedness, dizziness, or tension
in various body parts. His feeling the kind of anger that leads to violence signals
him to use the contract. If he cannot identify any cues, then whenever he gets
angry, he will need to employ the contract.2.Examine what
he can do to control his explosive angerfor example, take a walk, jog, go
into another room, beat his fists on pillows, or vigorously play a sport. The
batterer must give the final sanction concerning what will work. It has to be
his decision drawn from what is normal and feasible in his life frame. Moreover,
his participation in deciding alternative behavior to violence conveys his responsibility
for change, which is an important shift. (The worker has to monitor its feasibility;
a car ride to cool off if he has a car that does not work properly would probably
increase his anger rather than decrease it.)3.Determine exactly
how much time is needed to calm down. It is necessary to be explicit and specific.
The specificity builds an external structure that will eventually be internalized.

BONDING4. Involve the partner in a cooperative execution
of the contract. Cooperating in a mutual effort for the benefit of each member
of the couple and the relationship teaches teamwork and provides an opportunity
for bonding. Of secondary benefit, it changes the victim-assailant roles. If she
participates and has influence, then her victim status changes. It is empowering
for her to be of constructive assistance. During the development of the contract,
she has input into whether she can agree to the terms of it. If she finds his
suggestions not feasible for her, then the two of them work on it until they reach
a mutual decision. The objective is to avoid violence; it supersedes other objectives
until successful.

DIRECTIVES5. Settle on a limited
number of times that the couple attempts to resume a discussion that escalates
to violent anger; my suggestion is no more than three times. If they cannot have
the discussion without escalating anger, then the topic is considered too volatile
and they are directed to table it until the session with the worker. If a volatile
topic triggers violent anger, the batterer is directed to employ the contract
as soon as he feels angry.6. Review what has been agreed upon to uncover
and correct any errors in the contract.7. Have each member of the
couple repeat the contract as many times as necessary until it is repeated
correctly. An angry batterer is out of control. He has not been able to draw on
inner resources to contain his anger; therefore, the worker must provide the structure
externally, which will eventually be internalized. Give a copy of the contract
to each partner, with instructions to put it in a place where there is ready access
and to review it regularly. (The refrigerator door is a good spot.)

In
the next and subsequent sessions, the worker reviews what transpired during
the week and whether the contract was used, as well as the outcome (Did it work?).
It is to be expected that the contract will have been broken initially. If violence
occurred, the consequences for the resumption of the violence must be put into
effect. The worker examines with the couple why the contract was not used. Is
the fault with the couple or the contract? If the former, it must be repeated
that the contract is to be used and when. If the problem is the terms of the contract,
the terms need to be altered. Sometimes what appears to be a feasible contract
on paper is not feasible in reality. Any new contract terms are repeated by the
worker, then the batterer, and then his partner until it is perfect, and then
it is written down. If the old contract is used, each partner repeats the contract
again.

Online Continuing Education QUESTION
14If the batterer thinks that other men may respond to a provoking partner
differently, in a non-violent way, he is faced with what? Record the letter of
the correct answer the Test.